Comprehensive Overview of CMS July 2024 OPPS Update (CR13632)

July 2024 OPPS Update

The CMS Releases July 2024 OPPS Update (reference: CMS Change Request CR13632, MLN Matters number MM13632). Here’s a summary of key changes:

  • New Coverage for COVID-19 Pre-Exposure Prophylaxis:
      • Drug: PEMGARDA (pemivibart) – Code: Q0224 (Note: This code is not reimbursed under OPPS, but at a “reasonable cost”)
      • Administration: Code: M0224 (Covered: Receives separate payment under OPPS)
      • Category: New Technology (APC 1506, Level 6) with reimbursement range of $401-$500.
      • Important: No patient cost-sharing applies for either code.

Additional Information:

  • The update also includes 26 new codes for proprietary laboratory tests.
  • For full details, refer to CMS Change Request CR13632.

Additional Highlights of the July 2024 OPPS Update (CR13632)

This update includes several other important changes for billing:

  • New Lab Tests: 26 new Proprietary Laboratory Analyses codes have been added (codes 0450U-0475U).
  • New Pass-Through Devices: Two devices received approval for pass-through status under OPPS:
    • C1605: Leadless dual-chamber pacemaker (implantable)
    • C1606: Single-use adapter for ultrasound on upper GI endoscopes
  • Device Clarifications:
    • C1601 (single-use pulmonary endoscope) excludes reprocessed devices.
    • C1602 (antimicrobial bone void filler) effective date clarified as January 1st.
  • Device Offset Updates:
    • The device offset for 0505T (when billed with C1604) is now $0 (effective January 1st, see transmittal 12421 or CR13488).
    • Pass-through status for C1761 (coronary lithotripsy catheter) expires June 30th.
  • New CPT® Category III Codes: 34 new codes were released in January and are effective July 1st.
  • Status Indicator Change:
    • 0621T (laser trabeculostomy) status changes to “J1” (paid under OPPS through APC 5492), effective January 1st.
  • New HCPCS Code:
    • C9901 (endoscopic GI tract defect closure) with status “J1” (paid under OPPS through APC 5362), effective January 1st.

Drug and Biological in July 2024 OPPS update (CR13632):

New Codes and Payment:

  • 6 new HCPCS codes for drugs/biologicals added. These are assigned status “G” (pass-through with separate APC payment).
  • J7353 (Anacaulase-bcdb gel): Status changed to “G” (pass-through with APC payment).

Ending Pass-Through Status:

  • Pass-through status is ending for 11 HCPCS codes on June 30th.

New and Deleted Codes:

  • 49 new drug/biological/radiopharmaceutical codes added.
  • Deleted codes effective July 1st:
    • J2780 – Injection, ranitidine hydrochloride;
    • J9371 – Injection, vincristine sulfate liposome;
    • Q4210 – Axolotl graft or axolotl dual graft; and
    • Q4277 – Woundplus membrane or e-graft.

Status Indicator Changes Delayed:

  • 9 HCPCS codes have status indicator changes. Due to issues, these will be published in October’s I/OCE (retroactive to July 1st).

New Skin Substitutes:

  • 23 new HCPCS codes for skin substitutes are effective July 1st.

Chargemaster Maintenance:

  • Reviewing July 2024 OPPS updates (like this one) is crucial for chargemaster coordinators. This helps identify:
    • New services to add
    • Code changes
    • Code deletions
  • Discuss these updates with relevant departments to ensure accurate billing for devices, drugs, and services.
  • A well-maintained chargemaster reduces claim denials.

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